| Doctor Name: | MRS. JUDITH JACQUES |
| NPI Number: | 1407894017 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LISW |
| License Number: | 113570 |
| Business Practice Address: | 409 Coleman Blvd. Suite 2b Mt. Pleasant, SC - 29464 |
| Business Phone Number: | 8433046400 |
| Business Fax Number: | 8436062500 |
| Mailing Address: | 997 Johnic Dodds Blvd., #1131 MT. PLEASANT |
| State: | SC |
| Postal Code: | 29464 |
| Phone Number: | 8433046400 |
| Fax Number: | 8436062500 |
| NPI Enumeration Date: | 06/04/2006 |
| NPI Last Update Date: | 04/27/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | 113570 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |